Advancing outcomes and quality of care: Data insights from essential hospitals
Every day, hospitals are being asked to provide a higher level of care for higher-acuity patients with fewer resources. In an era of rising complexity, benchmarking, shared learning and forecasting are essential practices to turn data into actionable insights. Through these efforts, health systems can identify opportunities and improve access, quality and efficiency, as well as anticipate change and mitigate risks across the System of CARE (clinical alignment and resource effectiveness).
America’s Essential Hospitals (AEH) members (“essential hospitals”) represent nearly 400 organizations delivering high-quality care to all people, including those facing social and financial barriers. AEH makes up approximately 5% of the nation’s hospitals but provides 28% of charity care nationally. These hospitals lead in advancing access and innovation, training the healthcare workforce and driving improvements in outcomes—while sharing a safety net mission to care for all people.
Analysis of 123 essential hospitals in the Vizient Clinical Data Base (CDB) shows that essential hospitals consistently deliver efficient, high-quality care despite treating more complex patients. All analyses include only continuously reporting hospitals for both the AEH cohort and total CDB hospitals, covering the time frame from Q4 2021 to Q2 2025.
- Essential hospitals experienced a 7.1% increase in inpatient discharges since 2019, representing a 42% higher growth than total CDB hospitals. Their case mix index (CMI) (2.85 vs. 1.80) and 60% higher expected average length of stay (ALOS) (9.67 vs. 6.03) underscore the more complex, high-acuity population they serve.
- Essential hospitals’ observed and expected ALOS are aligned, indicating effective management of higher-acuity patients consistent with expectations for their case mix. In contrast, overall CDB hospitals have a lower observed ALOS (5.48) compared to the expected ALOS (6.03), demonstrating stronger throughput performance relative to their population’s risk level. Both groups have shown continued improvement in their LOS index, reflecting reductions in observed ALOS relative to expected performance.
- Both groups demonstrated lower-than-expected mortality rates and substantial improvement in this index over time, with observed-to-expected mortality decreasing by 24.7% for essential hospitals and 25.8% for all hospitals.
- Thirty-day unplanned readmissions are 17.4% at essential hospitals versus 11.3% across CDB hospitals, both exceeding expected rates. Data trends underscore this as a key opportunity for performance improvement through strengthened post-acute care coordination to improve quality outcomes and capacity.
Essential hospitals manage high-vulnerability populations
The communities AEH hospitals serve were analyzed using the Vizient Vulnerability Index (VVI). The VVI assesses nine social drivers of health and the overall vulnerability index for each census tract and ZIP code across the U.S., which are calculated as standard deviations from the national mean. The nine drivers of health are economics, housing, education, social environment, neighborhood resources, public safety, healthcare access, transportation and clean environment. Any score greater than1 is considered an area of “high vulnerability.”
- Across the three VVI categories, essential hospitals maintain a consistently higher CMI than the CDB hospitals, with the highest CMI among CDB hospitals remaining below the lowest for the essential hospitals. This underscores essential hospitals’ role in caring for higher-acuity, more complex patients.
- Despite this complexity, mortality indices for essential hospitals remain below expected levels across all VVI categories, reflecting strong clinical performance despite serving patients with significantly higher social needs.
- LOS indices also are in line with expected levels across all VVI categories, suggesting efficient patient management regardless of vulnerability categorization.
Alyssa Harris and Jen Gof
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Deeper dive: Utilization across service lines
- Volume growth was experienced across most service lines for essential hospitals with double-digit increases in general medicine, trauma and neurology. Despite rising acuity and sustained utilization, shifts toward outpatient and community-based care have tempered growth in orthopedics and behavioral health volumes.
- Across every service line, essential hospitals report a longer ALOS than CDB hospitals, reflecting higher patient complexity and case severity.
- Behavioral health shows the largest percentage gap in ALOS between essential hospitals and CDB hospitals. Despite treating higher-complexity patients, essential hospitals have seen a decline in behavioral health volume since 2019, highlighting persistent capacity and access constraints and a continued effort to shift toward outpatient and community-based models. Sustained focus is essential, as the Impact of Change® forecast projects a 6.5% increase in demand nationally by 2035.
Managing post-acute transitions: LOS patterns by discharge status
- Essential hospitals have higher LOS indices across every discharge location compared with CDB hospitals.
- Patients discharged to skilled nursing and long-term care facilities show the largest increase in LOS over the more than five-year period. This suggests more exacerbated delays in post-acute placement for the patient populations essential hospitals serve and the opportunity for expanded post-acute care capacity through cross-continuum partnerships.
- Hospice discharges remain above expected LOS levels but have declined slightly since 2019, aligning with essential hospitals’ stable mortality rates. This trend suggests extended stays reflect more complex end-of-life care needs rather than inefficiency.
- Reductions in LOS for home, rehab and home health discharges indicate greater efficiency in managing lower-acuity transitions, balancing throughput gains against the continuing constraints in post-acute care access.
While inpatient psychiatric capacity within short-term acute care hospitals has declined over the past decade, several essential hospitals are taking proactive steps to strengthen behavioral health access. National analyses show that although the number of psychiatric beds in freestanding psychiatric hospitals—many now privately owned—have grown, inpatient units within short-term hospitals have steadily decreased, shifting where and how care is delivered. AEH members are expanding crisis response and stabilization models, integrating care through mobile crisis teams, jail-based treatment programs and new emergency psychiatry assessment, treatment and healing (EmPATH) or inpatient units. These efforts demonstrate how behavioral health capacity can be rebuilt through community partnerships and innovative service design.
Why it matters
As patient acuity and resource needs continue to rise, essential hospitals demonstrate that improved outcomes for vulnerable populations can advance through data-driven planning, coordinated care and community partnerships. Sustaining this progress will require stronger post-acute access, behavioral health integration and workforce alignment to ensure all patient populations receive high-quality care across the System of CARE. Key lessons include:
- Rising acuity and vulnerability are reshaping inpatient demand. Essential hospitals show that hospitals can sustain quality outcomes even as patient complexity intensifies.
- Behavioral health and post-acute resources are pivotal to meeting higher-acuity needs. Continued investment and innovative care coordination models will be crucial to close access gaps and improve patient transitions.
- Benchmarking drives continuous improvement. Comparing essential hospitals’ performance with national peers supports the development of actionable insights that help all hospitals strengthen readiness for higher-acuity, resource-limited futures.